The Influence of Environmental Air Pollution on Ventricular Arrhythmias:
A Scoping Review

Susil      Pallikadavath; Zakariyya      Vali; Roshan      Patel; Akash      Mavilakandy; Nicholas      Peckham; Matt      Clegg; Alastair   J.   Sandilands; G.   André   Ng

doi:10.2174/1573403X18666220416203716

Abstract

Introduction: Exposure to air pollution is a recognised risk factor for cardiovascular disease and has been associated with supraventricular arrhythmias. The effect of air pollution on ventricular arrhythmias is less clear. This scoping review assessed the effects of particulate and gaseous air pollutants on the incidence of ventricular arrhythmias.

Methods: MEDLINE and EMBASE databases were searched for studies assessing the effects of air pollutants on ventricular tachycardia and ventricular fibrillation. These pollutants were particulate matter (PM) 2.5, PM10, Nitrogen Dioxide (NO₂), Carbon Monoxide (CO), Sulphur Dioxide (SO₂), and Ozone (O₃).

Results: This review identified 27 studies: nine in individuals with implantable cardioverter defibrillators, five in those with ischaemic heart disease, and 13 in the general population. Those with ischaemic heart disease appear to have the strongest association with ventricular arrhythmias in both gaseous and particulate pollution, with all three studies assessing the effects of PM2.5 demonstrating some association with ventricular arrythmia. Results in the general and ICD population were less consistent.

Conclusion: Individuals with ischaemic heart disease may be at an increased risk of ventricular arrhythmias following exposure to air pollution.

Keywords: Air pollution, ventricular fibrillation, ventricular tachycardia, arrhythmia, supraventricular arrhythmias, cardiovascular disease.

[1]
Rajagopalan S, Al-Kindi SG, Brook RD. Air pollution and cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol  2018; 72(17): 2054-70.
 [http://dx.doi.org/10.1016/j.jacc.2018.07.099] [PMID: 30336830]

[2]
Brunekreef B, Holgate ST. Air pollution and health. Lancet  2002; 360(9341): 1233-42.
 [http://dx.doi.org/10.1016/S0140-6736(02)11274-8] [PMID: 12401268]

[3]
Thorpe A, Harrison RM. Sources and properties of non-exhaust particulate matter from road traffic: A review. Sci Total Environ  2008; 400(1-3): 270-82.
 [http://dx.doi.org/10.1016/j.scitotenv.2008.06.007] [PMID: 18635248]

[4]
Seaton A, MacNee W, Donaldson K, Godden D. Particulate air pollution and acute health effects. Lancet  1995; 345(8943): 176-8.
 [http://dx.doi.org/10.1016/S0140-6736(95)90173-6] [PMID: 7741860]

[5]
MacNee W, Donaldson K. Mechanism of lung injury caused by PM10 and ultrafine particles with special reference to COPD. Eur Respir J Suppl  2003; 40 (Suppl. 40): 47s-51s.
 [http://dx.doi.org/10.1183/09031936.03.00403203] [PMID: 12762574]

[6]
Laden F, Neas LM, Dockery DW, Schwartz J. Association of fine particulate matter from different sources with daily mortality in six U.S. cities. Environ Health Perspect  2000; 108(10): 941-7.
 [http://dx.doi.org/10.1289/ehp.00108941] [PMID: 11049813]

[7]
Harrison RM, Yin J. Particulate matter in the atmosphere: Which particle properties are important for its effects on health? Sci Total Environ  2000; 249(1-3): 85-101.
 [http://dx.doi.org/10.1016/S0048-9697(99)00513-6] [PMID: 10813449]

[8]
Organization WH. WHO Air quality guidelines for particulate matter, ozone, nitrogen dioxide and sulphur dioxide: Global update 2005 Summary of risk assessment 2005. Available from: https://apps.who.int/iris/bitstream/handle/10665/69477/WHO_SDE_PHE_OEH_06.02_eng.pdf

[9]
Guarnieri M, Balmes JR. Outdoor air pollution and asthma. Lancet  2014; 383(9928): 1581-92.
 [http://dx.doi.org/10.1016/S0140-6736(14)60617-6] [PMID: 24792855]

[10]
Akimoto H. Global air quality and pollution. Science  2003; 302(5651): 1716-9.
 [http://dx.doi.org/10.1126/science.1092666] [PMID: 14657488]

[11]
Shao Q, Liu T, Korantzopoulos P, Zhang Z, Zhao J, Li G. Association between air pollution and development of atrial fibrillation: A meta-analysis of observational studies. Heart Lung  2016; 45(6): 557-62.
 [http://dx.doi.org/10.1016/j.hrtlng.2016.08.001] [PMID: 27590407]

[12]
Link MS, Luttmann-Gibson H, Schwartz J, et al. Acute exposure to air pollution triggers atrial fibrillation. J Am Coll Cardiol  2013; 62(9): 816-25.
 [http://dx.doi.org/10.1016/j.jacc.2013.05.043] [PMID: 23770178]

[13]
Bhar-Amato J, Davies W, Agarwal S. Ventricular arrhythmia after acute myocardial infarction: ‘The perfect storm’. Arrhythm Electrophysiol Rev  2017; 6(3): 134-9.
 [http://dx.doi.org/10.15420/aer.2017.24.1] [PMID: 29018522]

[14]
Zhang S, Lu W, Wei Z, Zhang H. Air pollution and cardiac arrhythmias: From epidemiological and clinical evidences to cellular electrophysiological mechanisms. Front Cardiovasc Med  2021; 8: 736151.
 [http://dx.doi.org/10.3389/fcvm.2021.736151] [PMID: 34778399]

[15]
Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med  2018; 169(7): 467-73.
 [http://dx.doi.org/10.7326/M18-0850] [PMID: 30178033]

[16]
Arksey H, O’Malley L. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol  2005; 8(1): 19-32.
 [http://dx.doi.org/10.1080/1364557032000119616]

[17]
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ  2021; 372(71): n71.
 [http://dx.doi.org/10.1136/bmj.n71] [PMID: 33782057]

[18]
Zanobetti A, Coull BA, Gryparis A, et al. Associations between arrhythmia episodes and temporally and spatially resolved black carbon and particulate matter in elderly patients. Occup Environ Med  2014; 71(3): 201-7.
 [http://dx.doi.org/10.1136/oemed-2013-101526] [PMID: 24142987]

[19]
Feng B, Song X, Dan M, et al. High level of source-specific particulate matter air pollution associated with cardiac arrhythmias. Sci Total Environ  2019; 657: 1285-93.
 [http://dx.doi.org/10.1016/j.scitotenv.2018.12.178] [PMID: 30677895]

[20]
Cavallari JM, Fang SC, Eisen EA, Mittleman MA, Christiani DC. Environmental and occupational particulate matter exposures and ectopic heart beats in welders. Occup Environ Med  2016; 73(7): 435-41.
 [http://dx.doi.org/10.1136/oemed-2015-103256] [PMID: 27052768]

[21]
He F, Shaffer ML, Rodriguez-Colon S, et al. Acute effects of fine particulate air pollution on cardiac arrhythmia: The APACR study. Environ Health Perspect  2011; 119(7): 927-32.
 [http://dx.doi.org/10.1289/ehp.1002640] [PMID: 21398201]

[22]
Liao D, Whitsel EA, Duan Y, et al. Ambient particulate air pollution and ectopy--the environmental epidemiology of arrhythmogenesis in Women’s health initiative study, 1999-2004. J Toxicol Environ Health A  2009; 72(1): 30-8.
 [http://dx.doi.org/10.1080/15287390802445483] [PMID: 18979352]

[23]
Riediker M, Cascio WE, Griggs TR, et al. Particulate matter exposure in cars is associated with cardiovascular effects in healthy young men. 2004; 169(8): 934-40.
 [http://dx.doi.org/10.1164/rccm.200310-1463OC] [PMID: 14962820]

[24]
Cakmak S, Kauri L, Shutt R, et al. The association between ambient air quality and cardiac rate and rhythm in ambulatory subjects. Environ Int  2014; 73: 365-71.
 [http://dx.doi.org/10.1016/j.envint.2014.08.015] [PMID: 25226341]

[25]
Sarnat SE, Suh HH, Coull BA, Schwartz J, Stone PH, Gold DR. Ambient particulate air pollution and cardiac arrhythmia in a panel of older adults in Steubenville, Ohio. Occup Environ Med  2006; 63(10): 700-6.
 [http://dx.doi.org/10.1136/oem.2006.027292] [PMID: 16757505]

[26]
Yang M, Zhou R, Qiu X, et al. Artificial intelligence-assisted analysis on the association between exposure to ambient fine particulate matter and incidence of arrhythmias in outpatients of Shanghai community hospitals. Environ Int  2020; 139: 105745.
 [http://dx.doi.org/10.1016/j.envint.2020.105745] [PMID: 32334122]

[27]
Knezović M, Pintarić S, Mornar Jelavić M, et al. Correlation between concentration of air pollutants and occurrence of cardiac arrhythmias in a region with humid continental climate. Acta Clin Croat  2017; 56(1): 3-9.
 [http://dx.doi.org/10.20471/acc.2017.56.01.01] [PMID: 29119778]

[28]
Vaduganathan M, De Palma G, Manerba A, et al. Risk of cardiovascular hospitalizations from exposure to coarse Particulate Matter (PM10) below the European union safety threshold. Am J Cardiol  2016; 117(8): 1231-5.
 [http://dx.doi.org/10.1016/j.amjcard.2016.01.041] [PMID: 26976793]

[29]
Rich DQ, Balmes JR, Frampton MW, et al. Cardiovascular function and ozone exposure: The multicenter ozone study in oldEr subjects (MOSES). Environ Int  2018; 119: 193-202.
 [http://dx.doi.org/10.1016/j.envint.2018.06.014] [PMID: 29980042]

[30]
DiMarco JP. Implantable cardioverter-defibrillators. N Engl J Med  2003; 349(19): 1836-47.
 [http://dx.doi.org/10.1056/NEJMra035432] [PMID: 14602883]

[31]
Dales R, Lee DS, Wang X, et al. Do acute changes in ambient air pollution increase the risk of potentially fatal cardiac arrhythmias in patients with implantable cardioverter defibrillators? Environ Health  2020; 19(1): 72.
 [http://dx.doi.org/10.1186/s12940-020-00622-w] [PMID: 32552837]

[32]
Kim IS, Sohn J, Lee SJ, et al. Association of air pollution with increased incidence of ventricular tachyarrhythmias recorded by implantable cardioverter defibrillators: Vulnerable patients to air pollution. Int J Cardiol  2017; 240: 214-20.
 [http://dx.doi.org/10.1016/j.ijcard.2017.03.122] [PMID: 28392078]

[33]
Folino F, Buja G, Bertaglia E, et al. Association between air pollution and ventricular arrhythmias in high-risk patients (ARIA study): A multicentre longitudinal study. 2017; 1(2): e58-64.
 [PMID: 29851582]

[34]
Ljungman PL, Berglind N, Holmgren C, et al. Rapid effects of air pollution on ventricular arrhythmias. Eur Heart J  2008; 29(23): 2894-901.
 [http://dx.doi.org/10.1093/eurheartj/ehn463] [PMID: 19004842]

[35]
Rich DQ, Kim MH, Turner JR, et al. Association of ventricular arrhythmias detected by implantable cardioverter defibrillator and ambient air pollutants in the St.Louis, Missouri metropolitan area. Occup Environ Med  2006; 63(9): 591-6.
 [http://dx.doi.org/10.1136/oem.2005.023457] [PMID: 16698809]

[36]
Rich DQ, Schwartz J, Mittleman MA, et al. Association of short-term ambient air pollution concentrations and ventricular arrhythmias. Am J Epidemiol  2005; 161(12): 1123-32.
 [http://dx.doi.org/10.1093/aje/kwi143] [PMID: 15937021]

[37]
Dockery DW, Luttmann-Gibson H, Rich DQ, et al. Association of air pollution with increased incidence of ventricular tachyarrhythmias recorded by implanted cardioverter defibrillators. Environ Health Perspect  2005; 113(6): 670-4.
 [http://dx.doi.org/10.1289/ehp.7767] [PMID: 15929887]

[38]
Peters A, Liu E, Verrier RL, et al. Air pollution and incidence of cardiac arrhythmia. Epidemiology  2000; 11(1): 11-7.
 [http://dx.doi.org/10.1097/00001648-200001000-00005] [PMID: 10615837]

[39]
Metzger KB, Klein M, Flanders WD, et al. Ambient air pollution and cardiac arrhythmias in patients with implantable defibrillators. Epidemiology  2007; 18(5): 585-92.
 [http://dx.doi.org/10.1097/EDE.0b013e318124ff0e] [PMID: 17700247]

[40]
Langrish JP, Watts SJ, Hunter AJ, et al. Controlled exposures to air pollutants and risk of cardiac arrhythmia. Environ Health Perspect  2014; 122(7): 747-53.
 [http://dx.doi.org/10.1289/ehp.1307337] [PMID: 24667535]

[41]
Bartell SM, Longhurst J, Tjoa T, Sioutas C, Delfino RJ. Particulate air pollution, ambulatory heart rate variability, and cardiac arrhythmia in retirement community residents with coronary artery disease. Environ Health Perspect  2013; 121(10): 1135-41.
 [http://dx.doi.org/10.1289/ehp.1205914] [PMID: 23838152]

[42]
Folino AF, Scapellato ML, Canova C, et al. Individual exposure to particulate matter and the short-term arrhythmic and autonomic profiles in patients with myocardial infarction. Eur Heart J  2009; 30(13): 1614-20.
 [http://dx.doi.org/10.1093/eurheartj/ehp136] [PMID: 19411666]

[43]
Leaf DA, Kleinman MT. Urban ectopy in the mountains: Carbon monoxide exposure at high altitude  1996; 51(4): 283-90.
 [PMID: 8757408]

[44]
Bañeras J, Ferreira-González I, Marsal JR, et al. Short-term exposure to air pollutants increases the risk of ST elevation myocardial infarction and of infarct-related ventricular arrhythmias and mortality. Int J Cardiol  2018; 250: 35-42.
 [http://dx.doi.org/10.1016/j.ijcard.2017.10.004] [PMID: 29056239]

[45]
Link MS, Dockery DW. Air pollution and the triggering of cardiac arrhythmias. Curr Opin Cardiol  2010; 25(1): 16-22.
 [http://dx.doi.org/10.1097/HCO.0b013e32833358cd] [PMID: 19881339]

[46]
Kim JB, Kim C, Choi E, et al. Particulate air pollution induces arrhythmia via oxidative stress and calcium calmodulin kinase II activation. Toxicol Appl Pharmacol  2012; 259(1): 66-73.
 [http://dx.doi.org/10.1016/j.taap.2011.12.007] [PMID: 22197715]

[47]
Shahrbaf MA, Akbarzadeh MA, Tabary M, Khaheshi I. Air pollution and cardiac arrhythmias: A comprehensive review. Curr Probl Cardiol  2021; 46(3): 100649.
 [http://dx.doi.org/10.1016/j.cpcardiol.2020.100649] [PMID: 32839041]

[48]
Schwartz J, Litonjua A, Suh H, et al. Traffic related pollution and heart rate variability in a panel of elderly subjects. Thorax  2005; 60(6): 455-61.
 [http://dx.doi.org/10.1136/thx.2004.024836] [PMID: 15923244]

[49]
Breitner S, Peters A, Zareba W, et al. Ambient and controlled exposures to particulate air pollution and acute changes in heart rate variability and repolarization. Sci Rep  2019; 9(1): 1946.
 [http://dx.doi.org/10.1038/s41598-019-38531-9] [PMID: 30760868]

[50]
Mordukhovich I, Coull B, Kloog I, Koutrakis P, Vokonas P, Schwartz J. Exposure to sub-chronic and long-term particulate air pollution and heart rate variability in an elderly cohort: The Normative Aging Study. Environ Health  2015; 14(1): 87.
 [http://dx.doi.org/10.1186/s12940-015-0074-z] [PMID: 26546332]

[51]
Pieters N, Plusquin M, Cox B, Kicinski M, Vangronsveld J, Nawrot TS. An epidemiological appraisal of the association between heart rate variability and particulate air pollution: A meta-analysis. Heart  2012; 98(15): 1127-35.
 [http://dx.doi.org/10.1136/heartjnl-2011-301505] [PMID: 22628541]

[52]
Ng GA. Neuro-cardiac interaction in malignant ventricular arrhythmia and sudden cardiac death. Auton Neurosci  2016; 199: 66-79.
 [http://dx.doi.org/10.1016/j.autneu.2016.07.001] [PMID: 27423297]

[53]
Hausenloy DJ, Bøtker HE, Ferdinandy P, et al. Cardiac innervation in acute myocardial ischaemia/reperfusion injury and cardioprotection. Cardiovasc Res  2019; 115(7): 1167-77.
 [http://dx.doi.org/10.1093/cvr/cvz053] [PMID: 30796814]

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DOI https://dx.doi.org/10.2174/1573403X18666220416203716	Print ISSN 1573-403X
Publisher Name Bentham Science Publisher	Online ISSN 1875-6557

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